Using APIs to Improve Care and Efficiency

System for Health, Chicago, ILModi Boutrs – Chief App. Architect

Using APIs to Improve Care and Efficiency

Modi BoutrsChief Application Architect

Rush System for Health, Chicago, IL

PresenterPresentation NotesHi. I am Modi – Proud to work for Rush System for Health. I have a cool job to cater to do custom integration and development work and integrate with our beloved Epic EHR system, investigate new technologies and solutions that improve our patient life.

I am also so grateful for Rush System for Health for giving me this opportunity to utilize my experience to save patient lives.

One warning … I will be mentioning the word API a lot …. Because I love API(s).

• Rush University Medical Center► 669 bed Academic Medical Center► 35,000 Admissions/year► 65,000 Emergency Department visits/year

Overview of Rush

• Clinical Staff► 1,397 Professional Nursing staff► 813 Attending physicians► 644 Residents and fellows

PresenterPresentation NotesRush System - Rush university Medical Center

Our Great Clinical staff :

• Ambulatory Practices► ~50 owned practices► ~100 Private Practices

• Rush Oak Park Hospital

• Rush Copley Medical Center

Overview of Rush

• An academic health system whose mission is to improve the health of the patients and the diverse communities it serves with nationally recognized health care, education and research, as well as a commitment to community partnerships.

• The Rush system also includes Rush University, which has more than 2,500 students, and is a health sciences university that comprises Rush Medical College, the College of Nursing, the College of Health Sciences and the Graduate College.

Innovative Rush

PresenterPresentation NotesWe are Academic health system – mission to improve Health of the patients

I am blessed with great IS team … who is under our great visionary Dr. Shafiq Rab. Always tells us

• HL7 v2 is the fabric of any connected healthcare system.

API World…EHR Login

Assessment

ADT Event Push Data

3rd Party Processing

Clinician Login Outside of EHR

AssessmentFurther 3rd Party

Processing

Push Data Back to EHR

Find Data in EHR

Correlate, Analyze and Assess

...........

• Example – My Rush Mobile App

• How about external systems – real time requests?

• What about Mobile Applications?

• API(s) are the connecting link –

• Example of API - FHIR

PresenterPresentation NotesI am going to try to set us all on the same page…hopefully this slide help! bear with me, if you have any question… there will be time for Q&A..

We all agree HL7 v2 – is inner fabric of any hospital system. And works great…(click for a slide diagram). Look at diagram… when you send a msg, get Acknowledgement, Take about the diagram ADT and internal system response back. Event driven … wait for event to get triggered.Do Action / Response with Action

How about external systems? To some Extent HL7 But how about if you want to search Real time,

What about Mobile Applications? Most depends mobile apps depend on lightweight communications… real time. Security mechanisms, it becomes very cumbersome and tricky very quickly and you end up writing tons of functions and transformation….We start seeing the lacking of HL7v2HL7: EVERYONE has their own flavor of the standardEvent driven, transactional, push-modelSpecialized and non-portable training to become proficientNon-extensible and highly customized to confirm to workflows driving events and customization of standardMany moving parts with multiple points of failureNo inherent security

Solution is API. - Application Programing Interface.

A single extensible standardAPI model with standard REST protocols (put/get) for specific discrete data pointsStandard web programming proficiency used universally across industries (any developer will do)Highly extensible; allows for rapid development and reusable code regardless of workflow (even if you customize the original standard) [conformance statement]Few moving parts with known designated endpointsResult in highly-interoperable systemsOut of the box security (oAuth, Direct, etc)

FHIR -Fast Healthcare interoperability resources – further customize API to Healthcare needs…for example Patient is a resource, physician is a resource. Lightweight you can use JSON, XML and the language of mobility. This makes it easy for Patient Facing Mobile App to flourish – to improve patient health and outcome.

Let me give a real life example : my Rush Mobile and We rely on Some of great google cloud technologies that allows us to make it possible.

The MyRush MobilePlatform to keep patients connected and engaged with Rush Health Network to allow them manage their health and wellness.

It has features such as patient’s own EHR, including procedures, medications and test results.

Connects patients to their providers with real time appointments, secure messaging, and much more…

The MyRush app is available on iOS and Android Stores.

PresenterPresentation NotesFirst let me tell you what My Rush mobile is : Platform to keep All patients connected and engaged.…Build on top of Epic my chart SDK…. When we first released my Rush mobile… our own employees positive feedback was humbling…

I love it! All my medical information at my fingertips on my phone.Sabrina

Very user friendly app! I’m excited to see that you can refill prescriptions and set

up appointmentsAndrea

I like how you have the dosage for over the counter medications available on the app. It’s also easy navigation. Great set up!Thanks,Nick

I like this new app it is easy to use and has important

information that I sometimes had to have

written down elsewhere.…

Eleanor

Patient Feedback

PresenterPresentation NotesAbove are some examples…

This is realy the fuel that gives me purpose, makes me love what I do, and love API(s) … and allows me to keep going..

The MyRush Mobile App

Arrive via google maps

PresenterPresentation NotesWith the App…You can see doctors, schedule appointments, get directions, estimated waiting time, test results. Schedule Uber.

Scheduling / Searching / Registering

John Doe

1:30PM – ???? PM

Appointment Scheduled With John Doe

Search Get ScheduleCreate

OrLogin

PresenterPresentation NotesWithin Scheduling workflow, we have many feature uses multiple API calls for those who develop mobile applications know exactly what I am talking about…

for example as a patient you can Search…for a doctorget doctor’s scheduleLogin / Register – makes api call to 3rd Party verification and Create an accountSchecule appointmentPush notificationget ER wait timesThe list goes on and on…

- interacting with EHR, internal system, EPIC API..

Apple Health

PresenterPresentation Notes - Interact with Apple healthUse iOT such as wearables and SensorsAll that communicates via - Request and Response.. Real time asynchnrous calls

CMS Blue Button API

• Blue Button 2.0 from CMS is an API that contains four years of Medicare Part A, B and D data for 53 million Medicare beneficiaries.

• Information about a beneficiary’s health, including type of Medicare coverage, drug prescriptions, primary care treatment, and cost. Beneficiaries also have full control over how their data can be used and by whom, with identity and authorization controlled by MyMedicare.gov.

PresenterPresentation Notes

the app also interact / integrate with CMS blue button APIUsing FHIRAuthentications

Through Patient giving consent using oAuth, they can download their medicare record to their phone.

Litterally I am not exaggerating we have about 100 + API(S) with 700+ calls happen…. How can you manage that?

Drum roll……. Google has a solution. Called: Apigee

Apigee• Cross-Cloud API Management Platform• Design and Develop APIs• Secure and Monitor APIs

• Manage API Lifecycle

PresenterPresentation NotesHarmonious Ecosystem –Allows for hundreds of disparate systems, devices, IoEs, mobile apps, 3rd Party APIs to connect easily and communicate in harmony

Cross – Cloud API Centralized management Platform

One gateway to rule them allControl and shape trafficGranular access to servicesAuthorization & authenticationReal-time & predictive performance monitoring and alerting 3rd party documentation & guidanceCloud-based anytime/anywhere accessSecurityFacade abstracting internal network and application resourcesEncrypted at all levelsKnow who is connecting to what, when and whereMonitoring for malicious intentKeep the bad guys out and the good guys connected

As a developer:Design your api(S) specsDevelop your APIadd security mangage API lifecyle… Get analytics about your api

• The platform for designing APIs and transforming classic tech like SOAP to modern technologies

Apigee @ Rush3rd Party AppsExternal RushApps

FHIR/RESTful API Common Services Layer (CSL)

apigee API Management: oAuth, Direct, Security, Traffic

FHIR Library: Resources, Object Model, Validators (Open Source & Custom)

Orchestration: Integration, Legacy Translation (Open Source & Custom)

Internal RushSystems

PresenterPresentation NotesHere is example of how it looks at Rush

“With Apigee on top of the myRushapp we have enhanced the patient experience by putting the power in the hand of the patient to become the center of their own care.”

--Dr. Shafiq Rab

PresenterPresentation NotesGreat quote from Dr. Rab.

Apigee

PresenterPresentation NotesDemo – little techie talk. After all this is a lab..When you login to Apigee…. You see Develop…

Apigee

SpecsYAML

PresenterPresentation NotesCreate Specs using the YAML familiar structure…Yet Another Markup LanguageOriginally YAML was said to mean Yet Another Markup Language, referencing its purpose as a markup language with the yet another construct, but it was then repurposed as YAML Ain't Markup Language, a recursive acronym, to distinguish its purpose as data-oriented, rather than document markup.

Apigee

Develop

Publish

Secure with policy

Transform – XML, JSON, etc.

PresenterPresentation NotesDevelop APISecure with policy

Create a Pre and Post flow

Google Analytics API

Google Analytics (Used for analytics) https://developers.google.com/analytics/

PresenterPresentation NotesAnother product we heavily rely on to cater to our value patients is Google Analytics API…

Using Google Analytics to better understand patient priorities and predict their upcoming needs through intelligent application usage tracking

Tells us which features the patient is using the most…How often the app is used…If there is any crashes…What devices uses the app the most..

It just allows us to cater to our patient population needs based on realistic usage of the app.

https://developers.google.com/analytics/

// This function tracks screen viewsfun sendScreenViewToGA(screenName: String) {

if(BuildConfig.IS_GOOGLE_ANALYTICS_ENABLED) {

RushApplication.sTracker.setScreenName(screenName)

RushApplication.sTracker.send(HitBuilders.ScreenViewBuilder().build()) }}

PresenterPresentation NotesYou can enable it for specific screens as needed…

// This function tracks user clicks and menu selections

fun sendEventToGA(category: String, event: String) {

if(BuildConfig.IS_GOOGLE_ANALYTICS_ENABLED) {sendEventToGA(category, event, null, null)

}}

PresenterPresentation NotesYou can get into the details of tracking clicks on the menu of My Rush… and send it to Google Analytics

//This function tracks categories, events, and internal monitoring labelsprivate fun sendEventToGA(category: String, event: String, label: String?, value: Long? ) {

val eventBuilder = HitBuilders.EventBuilder()

eventBuilder.setCategory(category).setAction(event)

if (label != null)eventBuilder.setLabel(label)

if (value != null)eventBuilder.setValue(value)

RushApplication.sTracker.send(eventBuilder.build())

•Firebase Messaging (Used for push notifications)https://firebase.google.com/docs/cloud-messaging/

•Google Map API (Used for showing map and Directions) https://developers.google.com/maps/documentation/android-sdk/intro

•Google Distance Matrix API (Used for distance to Emergency room) https://developers.google.com/maps/documentation/distance-matrix/

Additional Google Cloud Products used in App.

https://firebase.google.com/docs/cloud-messaging/https://developers.google.com/maps/documentation/android-sdk/introhttps://urldefense.proofpoint.com/v2/url?u=https-3A__developers.google.com_maps_documentation_distance-2Dmatrix_&d=DwMGaQ&c=XxU8ngzB_WPJXKyiin_6iQ&r=c65evkytGJeenMtVotmEAX-NGlxKiTJgI_vUN7VeoU0&m=ZhJZp_U1CFNKtGYU5aiD-qWDKJ-x6tPv065tJ2u2DH8&s=EMdgbRJNJIK5F3mTWkOp__BtbICERY3IcNVSXnf8Nk4&e=

Other Google APIs…• Cloud DataFlow https://cloud.google.com/dataflow/

• CLOUD PUB/SUB https://cloud.google.com/pubsub

• Google BIGQUERY https://cloud.google.com/bigquery

PresenterPresentation NotesUsed by Rush BI team.

https://cloud.google.com/dataflow/https://cloud.google.com/pubsubhttps://cloud.google.com/bigquery

https://www.linkedin.com/in/modiboutrs/

@moboutrsFollow Me

Modi Boutrs

https://www.linkedin.com/in/modiboutrs/https://twitter.com/moboutrs

Using APIs to Improve Care and EfficiencyUsing APIs to Improve Care and EfficiencyOverview of RushOverview of RushInnovative RushAPI World…The MyRush MobilePatient FeedbackThe MyRush Mobile AppScheduling / Searching / RegisteringApple HealthCMS Blue Button APIApigeeApigee @ RushSlide Number 15ApigeeApigeeApigeeGoogle Analytics APISlide Number 20Slide Number 21Slide Number 22Additional Google Cloud Products used in App.Other Google APIs…Slide Number 25